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T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then devel...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166637/ https://www.ncbi.nlm.nih.gov/pubmed/34049931 http://dx.doi.org/10.1136/jitc-2021-002521 |
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author | Hammond, Sean Olsson-Brown, Anna Gardner, Joshua Thomson, Paul Ali, Serat-E Jolly, Carol Carr, Dan Ressel, Lorenzo Pirmohamed, Munir Naisbitt, Dean |
author_facet | Hammond, Sean Olsson-Brown, Anna Gardner, Joshua Thomson, Paul Ali, Serat-E Jolly, Carol Carr, Dan Ressel, Lorenzo Pirmohamed, Munir Naisbitt, Dean |
author_sort | Hammond, Sean |
collection | PubMed |
description | Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then developed a Stevens-Johnson syndrome reaction after coadministration of atezolizumab. Causality was confirmed by a positive re-challenge with amidotrizoate and laboratory investigations that implicated T cells. Importantly, the introduction of atezolizumab appears to have altered the immunologic response to amidotrizoate in terms of the tolerance–elicitation continuum. Proof of concept studies demonstrated enhancement of recall responses to a surrogate antigen panel following in-vitro (healthy donors) and in-vivo (ICI patients) administrations of ICIs. Our findings highlight the importance of considering all concomitant medications in patients on ICIs who develop immune-mediated adverse reactions. In the event of some immune-related adverse reactions, it may be critical to identify the culprit antigen-forming entity that the ICIs have altered the perception of rather than simply attribute causality to the ICI itself in order to optimize both patient safety and treatment of malignancies. |
format | Online Article Text |
id | pubmed-8166637 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-81666372021-06-17 T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab Hammond, Sean Olsson-Brown, Anna Gardner, Joshua Thomson, Paul Ali, Serat-E Jolly, Carol Carr, Dan Ressel, Lorenzo Pirmohamed, Munir Naisbitt, Dean J Immunother Cancer Case Report Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then developed a Stevens-Johnson syndrome reaction after coadministration of atezolizumab. Causality was confirmed by a positive re-challenge with amidotrizoate and laboratory investigations that implicated T cells. Importantly, the introduction of atezolizumab appears to have altered the immunologic response to amidotrizoate in terms of the tolerance–elicitation continuum. Proof of concept studies demonstrated enhancement of recall responses to a surrogate antigen panel following in-vitro (healthy donors) and in-vivo (ICI patients) administrations of ICIs. Our findings highlight the importance of considering all concomitant medications in patients on ICIs who develop immune-mediated adverse reactions. In the event of some immune-related adverse reactions, it may be critical to identify the culprit antigen-forming entity that the ICIs have altered the perception of rather than simply attribute causality to the ICI itself in order to optimize both patient safety and treatment of malignancies. BMJ Publishing Group 2021-05-28 /pmc/articles/PMC8166637/ /pubmed/34049931 http://dx.doi.org/10.1136/jitc-2021-002521 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Case Report Hammond, Sean Olsson-Brown, Anna Gardner, Joshua Thomson, Paul Ali, Serat-E Jolly, Carol Carr, Dan Ressel, Lorenzo Pirmohamed, Munir Naisbitt, Dean T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab |
title | T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab |
title_full | T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab |
title_fullStr | T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab |
title_full_unstemmed | T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab |
title_short | T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab |
title_sort | t cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166637/ https://www.ncbi.nlm.nih.gov/pubmed/34049931 http://dx.doi.org/10.1136/jitc-2021-002521 |
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